Surgery is not needed to treat most hemorrhoids. It is usually considered only after other treatments (including home treatment) have failed. Surgery is also considered when symptoms become so bothersome that a person's lifestyle is affected or when the hemorrhoids are creating a medical emergency.
External hemorrhoids are not usually removed with surgery (hemorrhoidectomy). External hemorrhoids may be treated with surgery in the following cases:
- The hemorrhoids are large and very uncomfortable, making it painful to keep the anal area clean.
- The person is having surgery on the anal area for other reasons, such as internal hemorrhoids or a tear (anal fissure) in the lining of the end portion of the large intestine (anal canal).
Because there are always risks associated with surgery, and because recovery times after surgery are often long (2 to 3 weeks), surgical treatment is a last resort for treating small internal hemorrhoids.
Seek a second opinion if your doctor recommends surgery to treat small internal hemorrhoids (unless you have large internal hemorrhoids as well or both internal and external hemorrhoids).
Surgical removal of hemorrhoids (hemorrhoidectomy) is considered the most successful way to treat:
- Large internal hemorrhoids.
- Large internal hemorrhoids that are still a problem after procedures that cut off blood flow to hemorrhoids (fixative procedures) have been tried.
The surgical option for hemorrhoids is a hemorrhoidectomy (mostly for large internal hemorrhoids).
What to Think About
Surgery should be not be done if a person has severe inflammation of the anal area. Long-term disorders of the digestive tract, such as ulcerative colitis, can cause anal inflammation.
Hemorrhoidectomy versus fixative procedures for internal hemorrhoids
- Procedures that cut off the blood flow to hemorrhoids (fixative procedures) are usually tried before surgery if hemorrhoids are small. (For more information about fixative procedures, see the Other Treatment section in this topic.)
- Hemorrhoidectomy should be considered when hemorrhoids either are very large or continue to cause symptoms or recur after fixative treatment has been tried.
- Hemorrhoidectomy may provide better long-term results than fixative procedures. However, surgery is more expensive, requires longer recovery times, is usually more painful, and has a greater risk of complications.
- Fixative procedures are the preferred treatment for people older than age 70 and those in poor health.